In testimony at the recent FDA Ophthalmic Devices Advisory Panel meeting, Jennifer Morse, MD, expressed her medical opinion about quality-of-life issues for some post-LASIK patients. For more than 10 years, Dr. Morse has investigated the effect of psychological factors on refractive surgery patients and the quality-of-life issues they experience. She is a board-certified psychiatrist with a subspecialty in psychosomatic medicine, which focuses on the interrelation between psychological and physical symptoms.
Dr. Morse testified that psychological well-being is an important part of a person's quality of life and that depression, which is known to occur in 20 million Americans during any 1-year period, is a widespread cause of diminished quality of life. The origin of depressive experiences, however, is unlikely to be due to a single incident or factor, according to Dr. Morse. During her testimony, she described the importance of better understanding a patient's subjective experience before, during, and after a LASIK procedure.
ORIGINS AND COURSE OF DEPRESSION
Dr. Morse told the panel that, when examining the origins and course of depression in an individual, one must take into account his background, personality, environment, coping skills, and outlook on life as well as any genetic predisposition.
"Depression is a complex mental illness, and while one factor may play a role, it isn't simply a matter of cause and effect," Dr. Morse stated. "There's no scientific evidence of any direct link between LASIK and the development of depression or suicide."
She went on to say that studies of other elective procedures, such as back or cosmetic surgery, have found associations between preoperative psychological factors (such as depression and anxiety) and a patient's perception of the surgical outcome and his level of function postoperatively.1-4
POST-LASIK DEPRESSION AND SUICIDE
Dr. Morse told the panel that, according to current knowledge, patients' quality of life after refractive surgery is similar to that of individuals who have never lived with refractive error and better than that of people who wear contact lenses and/or eyeglasses.5
"In a study published in 2007, glasses and contact lens users had lower quality-of-life scores than those patients treated with LASIK, or those who naturally see 20/20," Dr. Morse explained. "A statistically higher percentage of glasses and contact lens users had concerns about injury, difficulty coping with demands in life, difficulty fulfilling roles, and less confidence in everyday activities."5
Dr. Morse said that physicians need to take post-LASIK quality-of-life complaints seriously, but, at the same time, the real causes of these complaints in all their complexity must be understood.
"The results of the study proposed by the Joint LASIK Study Task Force will provide a new base of knowledge that may help us provide additional screening and pre- and post-LASIK counseling that addresses these factors and steer some people away from LASIK," she testified. "The study's results may also provide advice as to how to guide others through the procedure in a different way based on their level of psychological risk, and, in the end, lead to better experiences. This is our ultimate goal."
Jennifer Morse, MD, is in private practice in San Diego. She is a consultant to the ASCRS, and the society paid for her travel expenses to the most recent FDA Ophthalmic Devices Panel Meeting. Dr. Morse may be reached at (619) 405-5919; email@example.com.